Drummer Olaf H
Department of Forensic Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Southbank, Victoria, Australia.
Forensic Sci Res. 2018 May 7;4(2):95-110. doi: 10.1080/20961790.2018.1460063. eCollection 2019.
Drugs related to morphine represent not only large range of important therapeutic applications for the relief of moderate to severe pain but also give rise to a relatively large series of novel opioids that mimic the action of this naturally occurring analgesic. Most of these are based on fentanyl structures that are much more potent, and dangerous, than fentanyl itself. This publication reviews reports of fatalities attributed to 15 novel opioids with the view to assessing mortality associated with their misuse as well as reviewing published analytical procedures that would be able to detect these and other novel opioids. These drugs include reports of deaths to acetylfentanyl, acrylfentanyl, butr(yl)fentanyl, carfentanil, 2- and 4-fluorofentanyls, 4-fluorobutyrfentanyl, 4-fluoroisobutyrfentanyl, furanylfentanyl, α- and 3-methylfentanyls, 4-methoxyfentanyl, ocfentanil, as well as AH-7921, U-47700 and MT-45. Most of these cases reporting a drug-caused death involved other drugs in addition to the opioid. No obvious minimum fatal concentration was discerned for any of the opioids for which details were provided, however, the more potent members required detection limits well under 1 ng/mL and often even well below 0.1 ng/mL requiring use of the most sensitive mass spectral detection procedures, particularly when screening specimens using a non-targeted mode. Four other novel opioids have been reported in admissions to hospitals include 4-chloroisobutryfentanyl, cyclopentylfentanyl and tetrahydrofuranfentanyl, all of which are likely to have the potential to cause death. It is also likely that other analogues will appear with time.
与吗啡相关的药物不仅在缓解中度至重度疼痛方面有广泛的重要治疗应用，还产生了一系列相对新颖的阿片类药物，它们模仿这种天然存在的镇痛药的作用。其中大多数基于芬太尼结构，比芬太尼本身效力更强且更危险。本出版物回顾了归因于15种新型阿片类药物的死亡报告，旨在评估与其滥用相关的死亡率，并回顾已发表的能够检测这些及其他新型阿片类药物的分析程序。这些药物包括乙酰芬太尼、丙烯酰芬太尼、丁酰芬太尼、卡芬太尼、2-氟芬太尼和4-氟芬太尼、4-氟丁酰芬太尼、4-氟异丁酰芬太尼、呋喃基芬太尼、α-甲基芬太尼和3-甲基芬太尼、4-甲氧基芬太尼、奥芬太尼以及AH-7921、U-47700和MT-45的死亡报告。大多数报告药物致死的案例除了阿片类药物外还涉及其他药物。对于提供了详细信息的任何阿片类药物，均未发现明显的最低致死浓度，然而，效力更强的成员需要检测限远低于1 ng/mL，甚至常常远低于0.1 ng/mL，这需要使用最灵敏的质谱检测程序，尤其是在以非靶向模式筛查标本时。在医院收治病例中还报告了另外四种新型阿片类药物，包括4-氯异丁酰芬太尼、环戊基芬太尼和四氢呋喃芬太尼，所有这些都可能有致死人的潜力。随着时间的推移，很可能还会出现其他类似物。
